New directions in MEN1 management: navigating the new clinical practice guidelines

Multiple endocrine neoplasia type 1 (MEN1) remains a clinically challenging syndrome due to its genetic heterogeneity, variable penetrance, and lifelong surveillance needs. The newly published 2025 MEN1 guidelines introduce important refinements in managing this complex hereditary syndrome, reflecting 2 decades of accumulated clinical experience and molecular insights. This review provides a concise overview of these recommendations and a systematic comparison with the previous MEN1 guideline as well as other recent international guidelines. This comparison points out fundamental advances in genetic interpretation, risk stratification, and therapeutic decision-making, highlighting both the progress towards standardization and the persistent controversies that underscore the complex interplay between evidence, pragmatism, and individualized care. The novel guidelines show essential directions for future research in MEN1.